Form ITA-XXXXP Consolidated list of all client questions

FORM ITA-4133P

Page 26 of 7

OMB Control No. 0625-0143

Expires 07/31/2018

OMB Control # 0625-0143

Expiration Date: xx/xx/xxxx

Contact Questions

Contact Types:	Data:
Primary	Salutation
Administrative	First Name
Alternate	Last Name
Purchaser	Title
Recipient/End User	Telephone
Requestor	Fax
Decision Maker	Email
President/CEO	Cell/Mobile Number
Auditors	User ID and Password
Shareholders
Board of Directors
International Marketing Manager
Banker
In-country representative
Mission sponsor
Principal US Subcontractors
Organization Types:	Data:
Client Organization	Name
Associate organizations	Address 1
Division or Subsidiaries	Address 2
Ownership/Parent Organization	City
Bank	State
Corporate	Zip code
Headquarters	Website
Sponsoring organization	Telephone
Organization Type:	Data:
	Manufacturer
	Service provider
	Educational Institution
	Franchisor (Master, Unit)
Client Type:	Data:
	US organization
	Foreign organization
	Student/General Public
	Researcher
	Other
General information:	Data:
	Name and contact info for company official in charge of international sales/marketing
	Name and contact information for company official in charge of financing
	If this company is a subsidiary, the parent company(ies) and any controlling individual(s)
	Are you currently working with a US Export Assistance Center, Dept of Commerce, US Embassy or other government organization
Domestic only
	Product/service contain 51 percent US content
	Share information with other TPCC agencies
International only
	Agent/Rep/Distributor
	Importer
	Area Developer
	Delegation

Organization Questions

Organization Types:	Data:
Client Organization	Number of employees
Associate organizations	Ownership percentage
Division or Subsidiaries	Securities Exchange Commission affiliation/reporting
Ownership/Parent Organization	Organization description
Bank	Annual sales
	Percent of revenue generated through exports
	Year organization established
	Federal Tax ID number or EIN
	Trade License Number
	NAICS code/category
	HS code
	IRS waiver form
	ISO 9000 registered
	TQM/Six Sigma certified
	Working towards certification
	Anticipated year to complete certification
	Product/service description
	Preferred business language
	Foreign-language speaking staff
	Staff with applicable qualifications to work on foreign enterprise projects
	Chamber registration number
	Safety record
	Financial data information
	Capital structure
	Countries in which sales are made in order of importance
	Under which state's law is your organization organized
	Is your company register with the state or Commonwealth and provide name
	Duns and Bradstreet number
	Not counting your profit margin, what percent of the cost to your foreign buyer derives from US sources
	Agreement concerning bribery and corporate policy prohibiting bribery
	Certification
	Who are your major competitors
	List the most important end-users or end-user industries for this product
	Export Control Classification Code
	Does the product require any special technical support or after-sales service
	Is your company willing to modify its product to meet foreign standards
	Does the product have patent/trademark/copyright registration
	Describe product/service competitive advantages, unique selling proposition, applications, and unique features that differentiate your product from competition
	Is product/service currently being sold in US
	Benefits/unique features
	US good provided by your company
	List name and location of other companies
	US services provided by your company
	What is your organization's primary function the XXX industry
	If you don't manufacture the product, provide name and location of manufacturers’ headquarters
	If not manufacturer, does your firm have documented sales or distribution authorization for the product
	Please list end-users and/or industries that use this product
	Will patent/trademark/copyright protection abroad be necessary
	Can the company promptly fill any new export orders from its present inventory
	How is your product typically distributed and marketed in the US and other countries
	Product/service wishing to export
	Is the company's product sourced/produced entirely in the US?
	Does US content represent at least 51% of the value of the finished product?
	How would you describe your firm's top management commitment to supporting export activities?
	Does your firm have a US marketing plan?
	If no, does your company need help developing one?
	What are the company's international sales objectives for the next 3 years (as % of total sales)
	What prompted your company to export?
	How is your company planning to develop sales in target markets?
	What domestic channels of distribution does you company employ?
	Number of employees whose jobs are attributable to exporting:
	Export stats: Year, total sales, export sales, percent exports to total sales, income from licensing agreements.
	Name key exporting problems
	Name factors that could inhibit international sales of your company or company's products/services.
	What specific innovations can you offer to foreign enterprise?
	Trade references (name/product, country, year, volume)
	If export rights are limited to a number of countries, please list countries.
	Referral OIO, ODO, IBP, Trade Missions, Partner, CS Event
	Under which state's laws is your organization organized
	Are you the rights holder or do you have the legal right to sell or distribute the export for which you are asking for assistance in the foreign market or markets in question?
	Provide relevant industrial economic sector(s)
	Provide overall economic value of the project or transaction
	Value and detailed description of all projected US export content
	States from which the projected US export content will be sources
	How will this project/transaction affect the environment?
	Type of educational institution
	Total number of undergraduate/graduate students
	Accrediting body
	Number of international students on campus
	Number of international students from the country of interest
	List degrees offered
	Brief description of your educational institution
	Describe the programs/degrees and any unique programs or characteristics
	Do you have the following available for international students (check all that apply)
	Minimum TOFEL score required
	Do you accept IELTS?
	Do you have an international marketing plan?
	What international marketing and promotional methods have you used?
	Have you ever participated in any of the following CS services (check all that apply)?
	What type of contacts are you seeking (check all that apply)?
	Describe any preferences, qualifications, servicing capabilities, requirements, or pre-qualifications that ideal prospects must have, such as English language ability, etc.
	Please List any specific educational institutions, associations, agents, etc., that you would like us to contact.
	Please List any specific educational institutions, associations, agents, etc., that we should not contact.
	If setting up an overseas campus, please describe the financial benefits to the US.
	Is your institution seeking representation on an exclusive basis in this market?
	Do you have an exclusive arrangement with your current partner?
	Is your representative aware that you are seeking additional representation?
	Desired Locations/Cities
	Additional Services (please note any other assistance that would be required)
	If academia, please check which best describes you: Faculty/Business; Faculty/Education; Faculty/Other; Student/Business; Student/Education; Student/Other
Exporter Types	Exporting Experience/Information
New-to-exporting	Number of years exporting
New-to-market	Products exported
Increase-to-market	Annual exports (% of total sales)
	Novice, Intermediate, Successful
	Countries exporting to (please provide the names of the countries to which you exported and the approximate dollar value of the organization’s worldwide exports for the last two calendar years)
	Countries of interest
	Does the product/service to be exported require any special technical support of after-sales service?
	Have you inquired about IP requirements in foreign markets?
	Which international distribution channels does your company currently use?
	Provide additional information that CS should be aware of to fully understand your company and its requirements.
	Are there specific export issues that you would like to discuss?
	Not counting your profit margin, what percent of the cost to your foreign buyer derives from US sources?
	Does the product/service to be exported require any special technical support of after-sales service?
	Do you have access to capital and can that money be dedicated to developing market share in one or more foreign countries?
	Do you have enough excess capacity to handle foreign sales orders?
	Do you have the resources in your company to learn about and comply with US export controls, foreign government import controls, foreign government regulations, and foreign cultural and business norms?
	Have you exported in the past two years and, if so, was it based on a deliberate plan or strategy?
	Company Export Profile
Marketing Client Types	How did you learn about this program?
US exporters	What promotional methods does your company use domestically?
Researcher	What type(s) of information were you looking for when visiting Export.gov
Student	How would you rate the overall usability of Export.gov?
General population	How would you change or improve the site?
	What enhancements would make it more useful?
	Did you know that you could sign-up for e-mail updates from Export.gov?
	Have you signed-up for any of our e-mail updates?
	How would you rate the overall usefulness of our e-mail updates?
	How could we make our e-mail updates more useful to you?
	How did you find out about this event: e-mail, media; printed press; website; other
	Do you have (foreign language)-speaking staff members with applicable qualifications that could work on foreign enterprise projects
	Other services or activities
	US goods provided by your company
	What markets/product categories does your organization represent or plan to represent in the (industry name) industry? Consumer Electronics: Audio; Emerging Technology; Automotive Electronics; Entertainment/Content; Computer Hardware & Software; Connected Home; Lifestyle Electronics, Content Distribution; Telecomm./Infrastructure; Digital Health and Fitness; Video; Digital Imaging/Photography; Wireless & Wireless Devices; Electronic Gaming; Other (Industry category names and subcategories selected via radio buttons change based on industry)
	What is your organization's primary function in the (industry name) industry? Consumer Electronics: Buying Organization; Government; Services; Industry Organization; IT/MIS; Finance &Investment (Organization primary functions, category names and subcategories selected via radio buttons change based on industry)
	Associated Companies/Division or Subsidiaries
	What markets/product categories does your organization represent or plan to represent in the (industry name) industry? Consumer Electronics: Audio; Emerging Technology; Automotive Electronics; Entertainment/Content; Computer Hardware & Software; Connected Home; Lifestyle Electronics, Content Distribution; Telecomm./Infrastructure; Digital Health and Fitness; Video; Digital Imaging/Photography; Wireless & Wireless Devices; Electronic Gaming; Other (Industry category names and subcategories selected via radio buttons change based on industry)
	What is your organization's primary function in the (industry name) industry? Consumer Electronics: Buying Organization; Government; Services; Industry Organization; IT/MIS; Finance &Investment (Organization primary functions, category names and subcategories selected via radio buttons change based on industry)
	Trade license number
	BSP categories
	Additional BSP listings
	Authorization of overseas post to disclose name of client to the target company/individual
	Organization's objective
	Product/service wishing to import
	What type of business contacts are you seeking?
	Is your firm seeking representation on an exclusive basis in this market?
	Describe any preference, technical qualifications, servicing capabilities, requirements, or pre-qualifications that ideal prospects must have.
	Describe any special features of your company's operations, interests or objectives in the target market that can help us identify potential business partners.
	Is your company represented in the country/region?
	If yes, is this arrangement exclusive?
	Is your representative/partner aware you are seeking additional representation?
	List the most important end-users or end-user industries for this product
	How is your product typically distributed and marketed in other countries?
	Firms' objective to import: (Choose all that apply)
	What is the outcome or result you expect to accomplish by working with CS?
	What new markets are you targeting to expand future sales?
	List priority countries of most importance to you.
	For each market you have selected above, please specify questions/topics you would like to discuss with the Commercial Specialists
	The U.S Commercial Service has offices at US Embassies/Consulates in 82 countries. Can we be of assistance in any other markets?
	Are there any specific companies, or types of companies, you would like us to contact? If so, please name them.
	Are there specific companies you would not like us to contact? If so, please name them.
	If applicable, please provide the necessary contact information of your current representative/partner:
	Short Business Service Provider Description
	Complete Business Service Provider Description
	Description of company/products/services/objectives
	Benefits/unique features
	If you do not manufacture the product, provide name and location of manufacturer's headquarters
	If not the manufacturer, does your firm have documented sales or distribution authorization for the product?
	Please list end users and/or industries that use this product
	Describe product/services competitive advantages, unique selling proposition, applications, and unique features that differentiate your product from competition.
	Who are your major competitors?
	List the most important end-users or end-user industries for this product
	HS Code
	Import Control Classification Code
	Does the product require any special technical support or after-sales service?
	Is your company willing to modify its product to meet foreign standards?
	Does the product have patent/trademark/copyright registration?
	Will patent/trademark/copyright protection abroad be necessary?
	Can the company promptly fill any new import orders from its present inventory?
	Number of years importing
	Challenged, Mixed effective, effective
	Have you previously tried to import from the U.S.?
	Are you looking for representation in <country>?
	Does the product/service to be exported require any special technical support or after-sales service?
	Discuss Intellectual Property:
	Which international distribution channels does your company currently use?
	Provide additional information that CS should be aware of to fully understand your company and its requirements
	Are there specific import issues that you would like to discuss?
	How would you describe your firm's top management commitment to supporting import activities?
	Does your firm have an international marketing plan?
	If no, does your company need help developing one?
	What are the company's international sales objectives for the next 3 years (as % of total sales)
	What prompted your company to import?
	How is your company planning to develop sales in target markets?
	Name factors that could inhibit international sales of your company
	What specific innovations can you offer to (foreign enterprise)?
	Trade references (name/product, country, year, volume)
	If import rights are limited to a number of countries, please list countries
	How did you learn about this program?
	What promotional methods does your company use domestically?
	What type(s) of information were you looking for when visiting Export.gov
	How would you rate the overall usability of Export.gov
	How would you change or improve the site? What enhancements would make it more useful?
	Did you know that you could sign up for e-mail updates from Export.gov?
	Have you signed up for any of our e-mail updates?
	How would you rate the overall usefulness of our e-mail updates?
	How could we make our e-mail updates more useful to you?
	How effective is your company with the following activities: Conducting market research; developing business plans; marketing/selling internationally/ finding business partners; protecting intellectual property; ensuring compliance with US or foreign laws; managing payment/financing; shipping/preparing export documentation; ensuring sufficient production capacity.

Events & Activities Questions

Events & Activities
	Organization's objective
	What type of business contacts are you seeking?
	Is your firm seeking representation on an exclusive basis in this market?
	Describe any preference, technical qualification, servicing capabilities, requirements, or pre-qualifications that ideal prospects must have.
	Describe any special features of your company's operation, interests or objectives in the target market that can help us identify potential business partners.
	Is your company currently represented in the country/region?
	If yes, is this arrangement exclusive?
	Is your representative/partner aware you are seeking additional representation?
	What is your organization's objective to export?
	What is the outcome or result you expect to accomplish by working with CS?
	What new markets are you targeting to expand future sales?
	Potential services: Market Research, Gold Key Service, International Company Profile, Advocacy, etc.
	Are there any specific companies, or types of companies, you would like us to contact?
	If so, please name them.
	Are there specific companies you would not like us to contact?
	If applicable, please provide the necessary contact information of your current representative/partner.
	Business Service Provider categories
	Additional Business Service Provider listings
	authorization of international posts to disclose name of client to the target company/individual
	Event name and date
	Event location
	Booth number at show
	Name of building and street address
	Name of fair grounds or other location which event will occupy
	Attach authority to occupy event site
	Attach license or permit to operate the event
	Date event opens
	Date event closes
	How is the event financed (state whether financed wholly by event operator or if supported or underwritten financially in whole or in part by other organizations. List organizations and financial obligation of each, including chambers of commerce, associations, business firms, city, state, or other government organizations).
	If no license or permit is required, please indicate this.
	Person(s) attending show
	Contact Titles and names at show
	What are your business objectives for attending (Name of trade show).
	Type of export counseling desired.
	International business in which your company is interested.
	Where are you most interested in marketing your product?
	Would you like a free subscription to Commercial News USA?
	Desired dates for services
	Alternate dates
	Desired locations
	Additional services (needed/requested)
	How interested are you in establishing a business connection with (name of organization) for export sales to (location)?
	Would you be able to establish a reliable supply chain to (organization)
	Explain advantages you can provide
	Describe the event in which the USG official is to participant (e.g., site visit, announcement, ribbon-cutting, business agreement signing).
	Identify all foreign and domestic entities involved, including ownership and control and role of each entity in the project. Entity/ownership, percent ownership of this project.
	Please identify decision makers for this event (Name, title, organization).
	Describe role of foreign business partner (s) (i. e. JV, etc) Provide name (s) address(es) and CEOs of foreign business partner or buyers
	What if any agreements/approvals have preciously occurred in connection with this project?
	What is your latest information on the status of this event?
	What additional actions must occur before the event can materialize (e.g., financing needs to be secured, permits obtained, Ministry approval, etc.)?
	List all signatories for any agreements to be witness (name, title, organization)
	Please describe the legal nature and impact of any document that will be signed.
	A draft press release from your company announcing the event.
	Specific points you would like the US government official to highlight regarding the event.
	Are you a member of the Industry Business Association/Club or Chamber of Commerce?
	Brief description of current business
	If you are an exhibitor at (event name), with is your booth number?
	Basic history or description of show.
	Specify product categories within this fair.
	Number of exhibitors/participants (US and others) expected
	Number of visitors expected
	If government, please check which best describes you: federal, state, local
	Please provide a description of your event.
	Outline your goals and objectives.
	Indicate names of VIP leaders, if appropriate.
	Proposed itinerary. Please give as much detail as possible.
	Services/assistance requested from the post if status in approved (e.g., one-on-one business appoints, plant visits, translators, reception, hotel and transportation arrangements.
	Product categories/industries to be promoted.
	Target date of advance trip, name of advance officer.
	List any specific organizations, from the private and public sectors, with whom you know you, wish to meet.
	Outline of promotional campaign to be conducted in recruiting mission (e.g., mailing, fax campaign, brochure distribution at other trade events, radio spots).
	Be as specific as possible and include target dates, when available.
	Deadline for accepting applications from participants.
	Proof, such as a copy of letter of invitation, that your mission has a host organization in countries that require such as arrangement (e. g., China).
	Specify any need for special space and/or equipment for audiovisual presentations or technical programs.
	Please rank organization's top three objectives in participating in this trade mission (1=highest, 3=lowest). Choices are: finding a sales representative, finding licenses, finding joint venture partners, exposure to new business prospects, product testing/market research, immediate sales, finding a distributor, government meetings, other
	Please provide a brief description of how organization's participation is consistent with the goals and objectives of this mission, as set forth in the accompanying mission statement.
	Organization may provide any information that it considers relevant to the purpose of the trade mission regarding diversity and/or traditional under-representation in business.
E-Awards	Application Information: Type of Application Choices: E Award for Exports; E Award for Export Service; E Star Award for Exports; E Star Award for Export Service
	E Star Applicants: Year of previous E Award receipt:
	Company/Organization Name
	Division or subsidiary of:______________________________________
	Business or organization type (Manufacturer, Distributor, Trade Association, etc.):
	Description of product or service exported:________________________________
	Total number of countries currently exporting to:___________________________
	Top three countries of export for the previous four years:
	E Award for Exports or E Star Award for Exports Applicants: U.S. Export Statistics: Provide figures for each of the past four (4) years (either calendar or corporate fiscal), plus your most recent quarterly data. Data should include shipments to Canada and Mexico, but not Puerto Rico or the U.S. Virgin Islands. Do not include income from licensing agreements in sales figures; list licensing income separately
	1. What market research do you conduct?
	2. What is your international sales model? (E.g. direct sales, distributors/agents)
	3. What government and private sector export promotion events do you participate in?
	4. Describe any instances in which you had to retrofit or redesign products or services to sell them in an international market.
	5. What exporting-related training have you conducted for your employees and/or international customers?
	6. How do you overcome language obstacles with your international customers?
	7. Describe any trade barriers your organization has faced and how they were overcome.
	8. If applicable, describe how you have developed a market abroad for products not previously exported.
	9. If applicable, describe how you have opened a new market previously closed or extremely limited to American companies.
	10. Describe any other strategies you employ for increasing international sales.
	11. Describe how increased exports have affected employment for your organization.
	1. What seminars, workshops, or conferences has your organization conducted?
	2. How have you notified exporters of trade opportunities?
	3. What documentation assistance have you provided to exporters?
	4. Describe any overseas trade missions that you have sponsored.
	5. Describe any programs you provided for international businesses.
	6. Describe any other export services that you provide.
	7. Provide three cases studies describing exporters that have increased exports as a result of your help, being sure to describe the ways in which your activities helped; alternately, describe how the organization’s activities have resulted in community-wide export expansion.
Payment Information
Credit Card Information	Cardholder name
	Credit card type (Visa, Master card, etc)
	Expiration date
	Card number
Check Payment	Account holder name
	ACH/Routing number
	Account number
	Check number

Trade Leads Intake Form

U.S. Embassy/Consulate Commercial Specialist Responsible for Lead:

U.S. Embassy/Consulate Post:

Organization Name:*

Organization Address 1:*

Organization Address 2:

Organization City:*

Organization Country:*

Organization Web Site*:

Contact First Name:*

Contact Last Name:*

Title Within Organization:*

Email Address:*

Daytime Phone Number:*

Organization Type:*

Distributor/Representative

National Government

Export Management Company

Service Company

Franchiser

Retailer

Other, Please Specify

Brief Company/Entity Description:*

Companies You Currently Represent:

For Tenders Trade Leads - Companies That are Already Pre-Qualified:

Is there a Local Content Requirement? If So, How Much?

Yes

If Yes, How Much?

No

Is There a Sovereign or Corporate Guarantee for This Project? *Imperative to Know this For ExIm Financing.                        

Yes

No

Can Bid be Submitted in English?                    

Yes

No

Information

Describe the product/service(s) you are looking for.  Please be as specific as possible.*

If You Already Have a U.S. Supplier(s) in Mind, Please Indicate the Company of Interest Below.

Quantity Needed:

Price Range/Dollar ($) Value:

Purchase Needed By/Submission Deadline:*

What Type of Business Contacts You Are Seeking:*

Manufacturer

Joint Venture Partner or Licensee

Agent / Sales Representative

Franchisee

Other, Please Specify:  

Thank you for submitting a trade lead!  Please continue by filling out the next section. Although this section is optional, this information will help us find you the right U.S. partner.

Sales Frequency:

Long Term Supplier

Short Term Supplier

Irregular Purchases

Single Purchase

Should Responding Firms Write in English or Another Language:

English

Other, please specify:

Do You Want Responses from U.S. Manufacturers Only or Are Agents and Distributors Acceptable?

U.S. Manufacturers Only

Agents and Distributors Acceptable

What Specific Information Do You Want U.S. Suppliers to Provide to You When They Respond?

List the Most Important End-Users or End-User Industries for This Product / Service:

What Type of Licensing or Registration Does the Product You Are Seeking Require in Your Country?

Is a Service Contract Required?                         

Yes

No

Please submit any support documents for this trade lead to Danielle.Caltabiano@trade.gov once this form has been submitted.

Team Leader Additional Comments

Advocacy Center Questions

Project

Name of the Project: Location of the Project: Country:

Applicant

Full Corporate Name: Headquarters Address:

Place of Domicile:

Organization Name:

City: State / Providence:

Country: Postal Code:

Ownership:

(Identify any Parent companies and the percentage of ownership of each parent)

Annual Sales ($): Number of Employees: U.S. Outside U.S. Website (URL):

Contact Person (This section must be completed if the applicant is represented by any independent third- party representative, consultant, or

agent in connection with this application).

First Name: _______________________ Last Name: __________________Title:

Company: ________________________ Telephone: ___________________ E-mail:

Certification

The undersigned, being so authorized, certifies on behalf of the applicant that, to the best of his/her knowledge, the information provided herein is complete and accurate, and all supplementary materials (as defined above) that may be provided at a later date shall be complete and accurate, and that the Company is in compliance with applicable U.S. law.

[Signature of Authorized Company Official] [Signature of Authorized Official of Bidder of Record, if applicable]

[Type/Print Name] [Type/Print Name]

[Title] [Date] [Title] [Date]

PROJECT/TRANSACTION

1. Please provide a description of the overall project? (What you’re doing for the customer).

2. What is the current status of the foreign government project or tender (include company interactions with foreign government decision-makers to date)?

3. Please provide the specific timeframes for when the project procurement actions will take place and when decisions will be made (if known).

Interim decision date: Final decision date:

4. Please indicate below the best estimate or actual dollar values contributed to this project/tender. Identify separately value(s) to be provided by domestic and/or foreign partners in a consortium, if applicable:

1. U.S. -sourced goods provided by your company

2. U.S. -sourced services provided by your company

3. U.S. -sourced goods provided by other companies

4. U.S. -sourced services provided by other companies

5. Total U.S. Goods/Services (a+b+c+d)

6. Foreign-sourced goods provided by your company

7. Foreign-sourced services provided by your company

8. Foreign-sourced goods provided by other companies

9. Foreign-sourced services provided by other companies

10. Total Foreign-sourced Goods/Services (f+g+h+j)

11. Total Project/Tender Value (e+j)

12. Percent U.S.-sourced Goods/Services (e/k) %

5. Please provide a description of: (number of units, type of work intended, and intended use)

1. 
   All project Goods/Services:

2. U.S. - sourced Goods/Services provided by your company:

3. U.S. - sourced Goods/Services provided by other companies:

List name and location of other U.S. companies supplying goods or services as part of your bid or proposal:

Company:	Location:
Company:	Location:
Company: Company:	Location: Location:

4. Foreign-sourced Goods/Services provided by your company:

5. Foreign-sourced Goods/Services provided by other companies:

List name and location of foreign companies supplying goods or services as part of your bid or proposal:

Company:	Location:
Company:	Location:
Company: Company:	Location: Location:

6. Please list the foreign government entity or entities responsible for awarding the project/tender and key foreign influencers

7. Are you the Bidder of Record?

☐Yes ☐No ^{(Please check one)}

If not, please provide the name and nationality of the Bidder of Record.

Name:____________________________ Nationality:

2. PARTNERSHIPS AND CONSORTIA

1. Are you bidding in a partnership or consortium with other companies?

☐Yes ☐No

If yes, please fill out partner(s) information in the provided box:

	Partner 1	Partner 2	Partner 3
Contact Name:
Title:
Nationality:
Address:
Telephone:
Email address:

2. From what State(s) will exports be made, if you are awarded the project/tender?

   State:	State:
   State:	State:
   State:	State:

3. Are you receiving advocacy or any other assistance from a foreign government in connection with this project/transaction?

☐Yes ☐No

3. COMPETITORS

Please identify all known competitors for this project/transaction and their nationalities:

1. U.S. competitors

   Company:	Company:
   Company:	Company:
   Company:	Company:

2. Foreign (Non-U.S.) competitors: (Please also list country of origin for each company)

Company: Company: Company:	Location: Location: Location:

4. LICENSING AND APPLICATIONS

1. Is this a request for: (please check ONLY one)

☐Commercial (non-defense) Advocacy? ☐Defense Equipment Advocacy?

If this is for defense advocacy, please check one:

☐Foreign Military Sale(FMS) ☐Direct Commercial Sale (DCS) ☐Unknown

2. Will items or technology to be exported in connection with this project/transaction that require U.S. Government export licenses?

☐Yes ☐No

If yes, please list the license number(s) and/or application(s) and their status:

License/Application Number(s):

Status of Application:

5. FINANCING

1. How will the project be funded?

2. Has your company, the tendering authority, or any member of your consortium applied for financing/support from any public export finance institution (e.g. World Bank, multi-lateral development banks, EXIM, TDA, MDBs, OPIC, foreign export financing agencies)?

☐Yes ☐No

3. If yes, please provide the institution and status of application:

4. If no, indicate whether you plan to seek such financing support in the future: ☐Yes ☐No

6. REQUESTED ASSISTANCE

1. Reason for requested assistance:

2. Please highlight the competitiveness of your bid in terms of technology, price, full lifecycle cost, and best value: